Abstract
Little is known about the prevalence of focused expertise (special areas of expertise within a clinical field) among physicians, yet such expertise may influence how care is delivered. We surveyed general internists, pediatricians, cardiologists, infectious disease specialists, and orthopedic surgeons to describe the prevalence of focused expertise and identify associated physician and practice characteristics. About one quarter of generalists and three quarters of specialists reported a focused expertise within their primary specialty. Hospital-based physicians more often reported such expertise, and physicians reimbursed by capitation less often reported expertise. Learning how focused expertise affects processes and outcomes of care will contribute to decisions about physician training and staffing of medical groups.
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References
Beeson PB. The natural history of medical subspecialties. Ann Intern Med. 1980;93:624–6.
Langsley DG, Darragh JH, ed. Trends in Specialization: Tomorrow’s Medicine. Evanston, Ill: American Board of Medical Specialties; 1985.
American College of Physicians. The role of the future general internist defined. Ann Intern Med. 1994;121:616–22.
Fogelman AM. Strategies for training generalists and subspecialists. Ann Intern Med. 1994;120:579–83.
Butzin DW, Guerin RO, Langdon LO, Irwin CE. The certification process in adolescent medicine. J Adolesc Health. 1998;23:328–31.
The American Board of Medical Specialties. 1999 Annual Report and Reference Handbook. Evanston, Ill: American Board of Medical Specialties; 1999.
Keating NL, Zaslavsky AM, Ayanian JZ. Physicians’ experiences and beliefs regarding informal consultation. JAMA. 1998; 280:900–4.
Kassirer JP, Gorry A. Clinical problem solving: a behavioral analysis. Ann Intern Med. 1978;89:245–55.
Hannan EL, Kilburn H, Bernard H, O’Donnell JF, Lukacik G, Shields EP. Coronary artery bypass surgery: the relationship between inhospital mortality rate and surgical volume after controlling for clinical risk factors. Med Care. 1991;29:1094–1107.
Donohoe MT. Comparing generalist and specialty care: discrepancies, deficiencies, and excesses. Arch Intern Med. 1998;158:1596–1608.
Harrold LR, Field TS, Gurwitz JH. Knowledge, patterns of care, and outcomes of care for generalists and specialists. J Gen Intern Med. 1999;14:499–511.
Fletcher RH, Fletcher SW. Internal medicine: whole or in pieces? Ann Intern Med. 1991;115:978–9.
Fletcher RH, Fletcher SW. What is the future of internal medicine? Ann Intern Med. 1993;119:1144–5.
Conti CR. President’s page: concerns about fragmentation of adult cardiology. J Am Coll Cardiol. 1989;14:532–3.
Nolan JP. Internal medicine in the current health care environment: a need for reaffirmation. Ann Intern Med. 1998;128:857–62.
Organ CH. Fragmentation and specialization. Arch Surg. 1987;122:639.
Jordan GL Jr. The future of general surgery. Am J Surg. 1991;161:194–202.
American Medical Association. Physician Characteristics and Distribution in the U.S. 1997–98 ed. Chicago, Ill: Survey and Data Resources; 1997.
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Dr. Keating was the recipient of a National Research Service Award from the Agency for Healthcare Research and Quality, Rockville, MD, Dr. Ayanian was a Generalist Physician Faculty Scholar of the Robert Wood Johnson Foundation, Princeton, NJ. This study was supported by the Primary Care Research and Education Fund of Brigham and Women’s Hospital.
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Keating, N.L., Zaslavsky, A.M. & Ayanian, J.Z. Physicians’ reports of focused expertise in clinical practice. J GEN INTERN MED 15, 417–420 (2000). https://doi.org/10.1046/j.1525-1497.2000.08003.x
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DOI: https://doi.org/10.1046/j.1525-1497.2000.08003.x